BMI and related risk factors among U.S. Marshallese with diabetes and their families.

Objective: Examine cross-sectional associations between body mass index (BMI) and related health behaviors, barriers and facilitators to health care, and perceived health status among a sample of U.S. Marshallese adults with Type 2 diabetes and evaluate associations of interest between participants and their family members.Design: Cross-sectional baseline data were analyzed from participants in a diabetes self-management education intervention trial.Setting: Data collection took place in home or community settings through a community-academic partnership in Arkansas.Participants: Study participants consisted of U.S. Marshallese adults with Type 2 diabetes (N = 221) and their family members (N = 211) recruited through community settings.Intervention(s): N/A.Main Outcome Measure(s): Participants' height and weight were measured using standard protocols to calculate BMI (kg/m2). Diet, physical activity, health care access, financial strain related to health care, perceived health status, and health care satisfaction were measured using self-report surveys.Results: Participants' mean BMI was 31.0 (95% CI: 30.2-31.7), with over half of study participants and their family members' BMI falling in the obese category. Participants' BMI was positively associated with spreading health care bill payments over time (ß = 1.75 (SE = 0.87); p = 0.045). Positive associations between participants and their family members were observed for self-reported health status conditions, health care coverage, health care utilization, and health care satisfaction.Conclusion: Study findings highlight the high prevalence of obesity and related risk factors among U.S. Marshallese adults with Type 2 diabetes and emphasize the need for intervention strategies that build upon cultural strengths and target community, policy, systems, and environmental changes to address obesity and chronic disease in this marginalized community.

Anxiety and depression in Spanish-speaking Latina cancer patients prior to starting chemotherapy.

OBJECTIVE: Anxiety and depression can substantially impact the life of a cancer patient, but literature on emotional distress in the Hispanic cancer population is sparse. Additionally, the influence of psychosocial variables including age, acculturation, and spiritual well-being on emotional distress in this population remains unclear. The purpose of the present report was to assess the prevalence of anxiety and depression in Spanish-speaking Latina cancer patients preparing to begin chemotherapy and to explore the predictors and correlates of these outcomes. METHODS: Participants were 198 Spanish-speaking Latina cancer patients who completed measures of anxiety, depression, acculturation, and spiritual well-being prior to starting chemotherapy. RESULTS: Prevalence of clinically significant anxious symptomatology was 52%, and prevalence of clinically significant depressive symptomatology was 27%. Longer time since diagnosis and less acculturation predicted more severe anxiety, while longer time since diagnosis, less acculturation, and older age predicted more severe depression (Ps < .05). In multivariable analyses, only time since diagnosis emerged as a significant predictor of anxiety and depression when accounting for the influence of other variables. Greater spiritual well-being was correlated with both less severe anxiety and less severe depression (Ps < .001). CONCLUSIONS: The present findings document the high prevalence of emotional distress, particularly anxiety, in this patient population prior to chemotherapy initiation and identify several demographic and clinical factors associated with increased risk for heightened distress. Additionally, these findings suggest that interventions to address distress in this patient population would benefit from including components that seek to improve patients' spiritual well-being.

Rethinking barriers: a novel conceptualization of exercise barriers in cancer survivors.

Previous research suggests different types of barriers may demonstrate different relationships with intention to engage in health behaviors. This study explored global, practical, and health-related barriers' relationships with exercise intention and behavior among cancer survivors. The mediating role of intention in the barriers-behavior relationships was also evaluated. Cancer survivors (N = 152) completed self-report measures of exercise barriers, intention, and behavior at baseline and of exercise behavior two months later. Global barriers were negatively related (p < .01) and practical and health-related barriers were unrelated (ps ≥ .07) to exercise intention. Global and practical barriers were negatively related (ps < .01) and health-related barriers were unrelated (p = .48) to subsequent exercise behavior. Exercise intention did not mediate any barriers-behavior relationships. Results suggest that global and practical barriers should be targeted in barriers reduction interventions and highlight the intention-behavior gap problem. Future research should explore multidimensionality of barriers for other health behaviors.

Exploring enhanced menu labels' influence on fast food selections and exercise-related attitudes, perceptions, and intentions.

Labeling restaurant menus with calorie counts is a popular public health intervention, but research shows these labels have small, inconsistent effects on behavior. Supplementing calorie counts with physical activity equivalents may produce stronger results, but few studies of these enhanced labels have been conducted, and the labels' potential to influence exercise-related outcomes remains unexplored. This online study evaluated the impact of no information, calories-only, and calories plus equivalent miles of walking labels on fast food item selection and exercise-related attitudes, perceptions, and intentions. Participants (N = 643) were randomly assigned to a labeling condition and completed a menu ordering task followed by measures of exercise-related outcomes. The labels had little effect on ordering behavior, with no significant differences in total calories ordered and counterintuitive increases in calories ordered in the two informational conditions in some item categories. The labels also had little impact on the exercise-related outcomes, though participants in the two informational conditions perceived exercise as less enjoyable than did participants in the no information condition, and trends following the same pattern were found for other exercise-related outcomes. The present findings concur with literature demonstrating small, inconsistent effects of current menu labeling strategies and suggest that alternatives such as traffic light systems should be explored.

Understanding the Impact of Move Your Way Campaign Exposure on Key Physical Activity Outcomes - Results from a Multi-site Pilot Evaluation.

The Move Your Way® campaign was developed to encourage physical activity contemplators to get active. A pilot test of campaign implementation was conducted and evaluated in eight communities between March and October 2020. A web-based, cross-sectional survey of adults collected pilot campaign outcome data after campaign implementation. Differences in outcomes between exposed and unexposed groups across the communities were compared. A total of n = 5,140 responded to the survey. Across eight communities, those who reported campaign exposure had 7.2 (95% CI, 6.1-8.6) greater odds of being aware of the Physical Activity Guidelines for Americans (Guidelines) compared to unexposed respondents. Additionally, they had greater odds of identifying the correct aerobic and muscle-strengthening dosages and had 1.4 (95% CI, 1.1-1.6) greater odds of reporting meeting both the aerobic and muscle-strengthening Guidelines. In this pilot evaluation, reported exposure to Move Your Way is associated with higher odds of being aware of the Guidelines, knowing recommended dosages, likelihood of becoming more active in the future, higher physical activity self-efficacy, making a recent physical activity behavior change, and higher physical activity levels. The Move Your Way campaign can be used in communities to promote physical activity.

Managing Outliers in Adolescent Food Frequency Questionnaire Data.

OBJECTIVE: The goal of this study was to explore the impact of 5 decision rules for removing outliers from adolescent food frequency questionnaire (FFQ) data. DESIGN: This secondary analysis used baseline and 3-month data from a weight loss intervention clinical trial. PARTICIPANTS: African American adolescents (n = 181) were recruited from outpatient clinics and community health fairs. VARIABLES MEASURED: Data collected included self-reported FFQ and mediators of weight (food addiction, depressive symptoms, and relative reinforcing value of food), caregiver-reported executive functioning, and objectively measured weight status (percentage overweight). ANALYSIS: Descriptive statistics examined patterns in study variables at baseline and follow-up. Correlational analyses explored the relationships between FFQ data and key study variables at baseline and follow-up. RESULTS: Compared with not removing outliers, using decision rules reduced the number of cases and restricted the range of data. The magnitude of baseline FFQ-mediator relationships was attenuated under all decision rules but varied (increasing, decreasing, and reversing direction) at follow-up. Decision rule use increased the magnitude of change in FFQ estimated energy intake and significantly strengthened its relationship with weight change under 2 fixed range decision rules. CONCLUSIONS AND IMPLICATIONS: Results suggest careful evaluation of outliers and testing and reporting the effects of different outlier decision rules through sensitivity analyses.

Internalized weight bias and psychological wellbeing: An exploratory investigation of a preliminary model.

Although a growing body of literature demonstrates negative effects of internalized weight bias (IWB), the relationships between IWB and relevant social, psychological, and behavioral variables have not yet been evaluated systematically. The purpose of the present study was to create and assess a model of hypothesized risks and outcomes of IWB. In an online survey, 650 adult males and females completed self-report measures of IWB, self-esteem, weight-related stigma experiences, body-related shame, body satisfaction, societal influence on body image, appearance comparisons, binge eating, distress, and weight-related quality of life. The originally hypothesized model did not provide an adequate fit to the data. Iterative modifications were undertaken, and the resulting model, in which social factors were associated with IWB and body image-related constructs which were in turn associated with psychological and behavioral outcomes, provided excellent fit to the data (CFI > .99, SRMR = .02, and RMSEA = .03). Most model paths were similar for underweight or normal weight participants versus participants with overweight or obesity. This study represents an initial effort at constructing a comprehensive model of IWB that can be further refined in future research and used to help guide the development of related interventions.

Applying a multidimensional model of craving to disordered eating behaviors: Development of the Food Approach and Avoidance Questionnaire.

Despite revisions to the DSM-5, current diagnostic criteria poorly capture the phenomena of eating disorders. The construct of food craving may help to explain the range of disordered eating and compensatory behaviors, but current measures do not fully capture the construct. Borrowing from the substance use literature and emphasizing both approach and avoidance craving inclinations, the ambivalence model of craving (AMC) provides a useful framework for predicting broad patterns of disordered eating behaviors. This study sought to develop and preliminarily validate a multidimensional AMC-based measure of food craving. Items for the Food Approach and Avoidance Questionnaire were generated and development and validation data were collected via online survey from community-based adults and university students (N = 1,070). Exploratory factor and item response theory analyses were used for measure development. Linear regressions were used to examine convergent and discriminant validity. Exploratory sensitivity analyses included logistic regressions and receiver operating characteristic curves. As hypothesized, a 2-factor measure was supported. No sex differences emerged in item functioning. The approach factor was associated with greater trait food craving, more uncontrolled eating, and greater likelihood of meeting self-reported diagnostic criteria for bulimia nervosa and binge eating disorder. The avoidance factor was associated with higher levels of restrained eating, drive for thinness, and an increased likelihood of meeting self-reported diagnostic criteria for anorexia nervosa and bulimia nervosa. Preliminary data support a new multidimensional measure of approach and avoidance food craving with potential for a transdiagnostic conceptualization of disordered eating and compensatory behaviors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Weight Bias Internalization Scale: Psychometric properties using alternative weight status classification approaches.

The Weight Bias Internalization Scale (WBIS) was developed to facilitate systematic investigation of internalized weight bias, but the English version has not undergone confirmatory factor analysis (CFA). Additionally, it is unclear whether the measure can be used when participants are grouped based on self-perceived versus body mass index (BMI)-based weight status. The present study evaluated the WBIS in a sample of 243 male and female undergraduate students who were overweight/obese as classified by self-perception or BMI. After exclusion of Item 1 due to poor item-to-total correlation, Cronbach's alphas were .92 and .94 for the perception-based and BMI-based groupings, respectively. CFAs using the reduced 10-item scale with addition of modifications for correlated errors resulted in acceptable model fit for the one-factor model in both groupings. Findings suggest psychometric properties of the modified WBIS are acceptable and are similar for overweight/obese participants grouped by either perceived weight status or BMI.

Supportive care needs of oral cancer survivors: Prevalence and correlates.

OBJECTIVES: Many cancer survivors experience unmet supportive care needs. The oral cancer survivor population is growing; however, little is known about the unique needs of this group. The present study aimed to determine the supportive care needs of persons with oral cancer who had completed active treatment at least three months previously. MATERIALS AND METHODS: Oral cancer survivors (N=342) completed an online questionnaire that included the validated Survivors Unmet Needs Survey (SUNS). Relationships between SUNS subscales and various demographic, clinical, and psychosocial variables were examined in univariate and multivariate analyses. Survivors also indicated their top unmet needs and interest in supportive care services. RESULTS: Survivors reported substantial unmet needs across all domains, with many of the top unmet needs falling in the emotional domain. Poorer mental and physical health were associated with greater unmet needs across all domains. In each domain, select demographic and clinical variables also were associated with greater unmet needs in univariate and multivariate analyses. Survivors reported high rates of interest in several supportive care services including support groups and various forms of informational support. CONCLUSION: The present study highlights the significant burden of unmet supportive care needs in oral cancer survivors who have completed treatment and are coping with long-term ramifications of the disease and its treatment, reveals factors related to those needs, outlines these survivors' interest in a range of supportive care services, and suggests future research directions.